Can Doctors Ignore an Advance Directive in the ACT?
The short answer is: a valid Health Direction in the ACT is legally binding on clinicians and they must comply with it. The longer answer involves specific circumstances where compliance becomes legally uncertain — and those circumstances are where most real-world problems occur.
When Clinicians Must Follow the Health Direction
Under the Medical Treatment (Health Directions) Act 2006, a treating health professional who becomes aware of a written Health Direction must comply with it if they reasonably believe it complies with the Act and has not been revoked or changed. If the direction says no mechanical ventilation, the clinician must withhold or withdraw ventilation. There is no discretion to override based on clinical judgment or the doctor's personal views about the patient's best interests.
This differs from the Statement of Choices (which clinicians must "take into account" but can depart from) and from an EPoA attorney's legally effective substitute decision within the scope of the EPoA and its statutory limits.
When Compliance Becomes Uncertain
There are specific situations where a clinician might not follow a Health Direction, and each one creates a different legal question:
Doubts about capacity at execution — if the treating team has reason to believe the principal lacked decision-making capacity when they signed the Health Direction, they can challenge its validity. This typically arises when there is evidence of cognitive decline around the date of signing, or when the document was executed without a capacity assessment despite known dementia risk factors.
Ambiguous instructions — a Health Direction that says "no heroic measures" or "no extraordinary treatment" does not give clinicians enough specificity to act on. What counts as "heroic" is a medical judgment call, and doctors will default to providing treatment when the refusal is vague. Specific instructions ("withhold cardiopulmonary resuscitation," "withdraw mechanical ventilation if I have been unconscious for more than 72 hours") are much harder to sidestep.
Inconsistency with an EPoA — under section 19, if a Health Direction and EPoA for healthcare or medical research matters are inconsistent, the attorney follows the EPoA when the Health Direction was made first, and follows the Health Direction when the Health Direction was made after the EPoA. This is a documentation problem, not a clinical one.
Emergency situations — in a medical emergency, a clinician may not have time to verify the existence or validity of a Health Direction. Section 12 permits withholding or withdrawing treatment only when the clinician reasonably believes the direction complies with the Act and has not been revoked or changed. Section 16 protects a health professional who acts honestly in reliance on a decision reasonably believed to comply.
The Palliative Care Exception
One thing a Health Direction cannot do is override the duty to provide palliative care. Comfort measures — pain relief, symptom management, and palliative sedation — continue regardless of what the Health Direction says. A direction that attempts to refuse all pain medication, for example, would not prevent a clinician from administering comfort-focused care.
This is a deliberate legislative design: the right to refuse treatment does not extend to a right to suffer without relief.
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How to Write Instructions That Stick
The strongest Health Directions share several features:
- Name specific treatments — "withhold CPR" rather than "no resuscitation measures"
- Include clinical conditions — "if I have been diagnosed with a terminal illness with a prognosis of less than six months" or "if I am in a persistent vegetative state"
- Address capacity concerns — if there are concerns about cognitive decline, discuss the principal's capacity with a medical practitioner when signing
- Update regularly — a recently reviewed Health Direction carries more weight than one signed ten years ago with no subsequent review
The ACT Advance Directive & Living Will Kit provides clinical refusal templates with the specific language that creates binding obligations, plus guidance on the capacity assessment process to protect your Health Direction against validity challenges.
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